Citation Nr: 20007946 Decision Date: 01/30/20 Archive Date: 01/30/20 DOCKET NO. 19-12 802 DATE: January 30, 2020 ORDER A rating in excess of 50 percent for major depressive disorder (MDD) is denied. A rating in excess of 10 percent for carpal tunnel syndrome, right arm, is denied. A rating in excess of 10 percent for carpal tunnel syndrome, left arm, is denied. A rating in excess of 10 percent for left hip bursitis is denied. A rating in excess of 10 percent for femoral neck stress fracture of the right hip is denied. A rating in excess of 10 percent for a lower back strain is denied. A rating in excess of 10 percent for early degenerative changes of the left knee is denied. A rating in excess of 10 percent for a right knee strain is denied. A total disability rating based on individual unemployability due to service-connected disabilities (TDIU) is denied. FINDINGS OF FACT 1. The Veteran’s MDD was not shown to cause occupational and social impairment with deficiencies in most areas, or worse. 2. The weight of the evidence shows that the Veteran’s right arm has mild incomplete paralysis of the minor extremity, but does not show that paralysis is moderate, severe, or complete. 3. The weight of the evidence shows that the Veteran’s left arm has mild incomplete paralysis of the minor extremity, but does not show that paralysis is moderate, severe, or complete. 4. The Veteran’s left hip bursitis was not shown to result in any ankylosis, extension limited to 5 degrees, flexion limited to 45 degrees, limitation of abduction with motion lost beyond 10 degrees, hip flail joint, or impairment of the femur. 5. The Veteran’s femoral neck stress fracture of the right hip was not shown to result in any ankylosis, extension limited to 5 degrees, flexion limited to 45 degrees, limitation of abduction with motion lost beyond 10 degrees, hip flail joint, or impairment of the femur. 6. Even considering pain and functional loss, forward flexion of the thoracolumbar spine less than 60 degrees is not shown; combined range of motion of the thoracolumbar spine less than 120 degrees is not shown; muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis is not shown; ankylosis of the spine is not shown; and incapacitating episodes having a total duration of at least two weeks during a 12-month period are not shown. 7. The Veteran’s early degenerative changes of the left knee has not been shown to result in ankylosis; slight recurrent subluxation or lateral instability; dislocated or removed symptomatic meniscus; flexion functionally limited to 30 degrees or less; extension functionally limited to 10 degrees or more; an impairment of the tibia and fibula; or genu recurvatum. 8. The Veteran’s right knee strain has not been shown to result in ankylosis; slight recurrent subluxation or lateral instability; dislocated or removed symptomatic meniscus; flexion functionally limited to 30 degrees or less; extension functionally limited to 10 degrees or more; an impairment of the tibia and fibula; or genu recurvatum. 9. The Veteran’s service-connected disabilities do not prevent her from obtaining or maintaining substantially gainful employment. CONCLUSIONS OF LAW 1. The criteria for a rating in excess of 50 percent for MDD have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.321, 4.1, 4.3, 4.7, 4.21, 4.126, 4.130, Diagnostic Code 9434. 2. The criteria for a rating in excess of 10 percent for carpal tunnel syndrome, right arm, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.321, 4.1, 4.120, 4.123, 4.124a, 4.3, 4.7, 4.21, Diagnostic Codes 8599-8515. 3. The criteria for a rating in excess of 10 percent for carpal tunnel syndrome, left arm, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.321, 4.1, 4.120, 4.123, 4.124a, 4.3, 4.7, 4.21, Diagnostic Codes 8599-8515. 4. The criteria for a rating in excess of 10 percent for left hip bursitis have not been met. 38 U.S.C. § 1155, 5107; 38 C.F.R. §§ 4.1, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5250-5255. 5. The criteria for a rating in excess of 10 percent for femoral neck stress fracture of the right hip have not been met. 38 U.S.C. § 1155, 5107; 38 C.F.R. §§ 4.1, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5250-5255. 6. The criteria for a rating in excess of 10 percent for lower back strain have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.321, 4.1, 4.2, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5237. 7. The criteria for a rating in excess of 10 percent for early degenerative changes of the left knee have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.159, 3.321, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5256-5261. 8. The criteria for a rating in excess of 10 percent for a right knee strain have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.159, 3.321, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5256-5261. 9. The criteria for entitlement to TDIU have not been met. 38 U.S.C. §§ 1155, 5103; 38 C.F.R. §§ 3.340, 3.341, 4.16, 4.19. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from August 2009 to April 2011. Increased Ratings 1. A rating in excess of 50 percent for MDD is denied. The Veteran filed her claim for a rating in excess of 30 percent, which was received by VA on September 13, 2017. A May 2018 rating decision denied her claim, but a February 2019 rating decision subsequently found that the Veteran was entitled to a 50 percent rating, effective September 13, 2017. The Veteran is seeking a rating in excess of 50 percent for her MDD, from September 13, 2017 forward. MDD is evaluated under the General Rating Formula for Mental Disorders. 38 C.F.R. § 4.130, Diagnostic Code 9434. Under the General Rating Formula for Mental Disorders, a 50 percent rating is assigned when there is occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships. A 70 percent rating is assigned when a Veteran’s MDD causes occupational and social impairment with deficiencies in most areas such as work, school, family relations, judgment, thinking, or mood due to such symptoms as: suicidal ideation, obsessional rituals which interfere with routine activities; speech that is intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately, and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work like setting); and inability to establish and maintain effective relationships. A 100 percent rating is assigned when a Veteran’s MDD total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; and memory loss for names of close relatives, for the veteran’s own occupation, or own name. When rating a mental disorder, VA must consider the frequency, severity, and duration of the Veteran’s psychiatric symptoms, the length of remissions, and the Veteran’s capacity for adjustment during periods of remission. The rating agency must assign a rating based on all the evidence of record that bears on occupational and social impairment, rather than solely on the examiner’s assessment of the level of disability at the moment of the examination. When rating the level of disability from a mental disorder, the rating agency must consider the extent of social impairment, but cannot assign a rating solely on the basis of social impairment. 38 C.F.R. § 4.126. Furthermore, the specified factors for each incremental rating are examples, rather than requirements, for a particular rating. The Board will not limit its analysis solely to whether the Veteran exhibited the symptoms listed in the rating criteria. Mauerhan v. Principi, 16 Vet. App. 436 (2002). Indeed, the symptoms listed under § 4.130 are not intended to serve as an exhaustive list of the symptoms that VA may consider but as examples of the type of degree of symptoms, or the effects, that would warrant a particular rating. Mauerhan, 16 Vet. App. at 442 (2002). The Veteran’s actual symptomatology, and resulting social and occupational impairment, will be the primary focus when assigning a disability rating for a mental disorder, and the Veteran may qualify for a particular rating by demonstrating the particular symptoms associated with that percentage, or other symptoms of similar severity, frequency, and duration. Vazquez Claudio v. Shinseki, 713 F.3d 112, 116 (Fed. Cir. 2013). The evidence of record, which includes the Veteran’s VA treatment records and VA examination reports, do not establish findings consistent with a rating in excess of 50 percent, from September 13, 2017, forward. The Veteran’s treatment records show that her last psychiatric visit was in May 2016. The Veteran was afforded a VA examination in May 2018. The examiner noted that the Veteran was diagnosed with MDD, panic disorder, and unspecified anxiety disorder. The examiner reported that it was possible to differentiate what symptoms are attributable to each diagnosis. The examiner reported that the overlapping symptoms of the Veteran’s three diagnoses were sleep disruption, irritability, anger outbursts, reduced concentration, and isolative behavior. Her MDD was shown to cause periods of sadness, anhedonia, withdrawal/isolation, decreased libido, reduced motivation, feelings of hopelessness, and episodes of passive suicidal ideation. The examiner reported that the Veteran’s MDD was best summarized as occupational and social impairment with occupational decrease in work efficiency and intermittent periods of inability to perform occupational tasks, consistent with a 30 percent rating. The examiner noted that the portion of occupational and social impairment due to MDD was episodically severe impairment in family, social, and occupational role functioning. The Veteran reported that she was married with two children and that she gets along with her spouse and children well. She also reported getting along with her father, but not her mother. She reported one close friend, who she saw twice a week. She did not go to new places, as it made her nervous and if she had to speak to people she did not know, it would cause her to have a panic attack. The examiner reported that the Veteran’s symptoms were depressed mood, anxiety, panic attacks more than once a week, and chronic sleep impairment. The examiner noted that the Veteran’s affect was mildly dysphoric and was tearful during much of the interview. The Board notes that prior to the May 2018 rating decision, the Veteran’s psychiatric diagnosis was adjustment disorder, under Diagnostic Code 9440, but the diagnosis was changed to MDD. The examiner reported that the new diagnosis was a progression of the condition formerly diagnosed as adjustment disorder. The Veteran was afforded a VA examination in August 2018. The examiner noted that the Veteran had a diagnosis of MDD with anxious distress and panic disorder. The examiner attributed the following symptoms to the Veteran’s MDD; excessive worry, tension, difficulty concentrating, insomnia, persistent depressed mood, crying spells, feelings of worthlessness and hopelessness, and passive suicidal ideation with no plan/intent. The examiner reported that the Veteran’s MDD was best summarized as occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, consistent with a 30 percent rating. The examiner opined that it was not possible to differentiate occupational and social impairment that is caused by each mental disorder because there was significant overlap. The Veteran reported that she was close to her husband and two children, but the tension with her husband was a lot worse and they were having more arguments recently because of her irritability. She reported being close to her father, but distant with her mother. She reported having one close friend and did not socialize because of her anxiety. She reported that she last worked in October 2017 and had anger problems, she would start getting anxiety and lash out at her co-workers. She had panic symptoms two to three times per week while working and the symptoms of feeling overwhelmed, sense of doom, shortness of breath, chest discomfort, and sweating. She reported excessive worry and tension and that she slept about four to six hours a night. The Board has thoroughly reviewed the record and has given full consideration to 38 C.F.R. § 4.7 (where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned) and 38 C.F.R. § 3.102 (when there is an approximate balance of evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each issue shall be given to the veteran). In determining whether the Veteran meets the schedular criteria for a higher rating, the Board’s inquiry is not necessarily limited to the criteria found in the VA rating schedule. See Mauerhan, supra. Based on the above, the Board finds that the impact of the Veteran’s PTSD symptoms on her social and industrial functioning is not sufficient to approximate the degree of impairment in excess of a 50 percent rating. The evidence demonstrates that the Veteran’s psychological symptoms have manifested as occupational and social impairment with reduced reliability and productivity due to disturbances of mood, intrusive thoughts, anxiety, chronic sleep impairment, and irritable behavior. Critically, VA treatment records, as well as the VA examination report, have not shown that the Veteran had occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as near-continuous depression; suicidal ideation, obsessional rituals, illogical speech, near continuous panic or depression affecting the ability to function independently; spatial disorientation; neglect of personal appearance; impaired impulse control with periods of unprovoked irritability; difficulty in adapting to stressful circumstances; and the inability to establish and maintain effective relationships. 38 C.F.R. § 4.130, DC 9411. The Board recognizes that the Court has held that the criteria for a 70 percent rating “indicates that the presence of suicidal ideation alone, that is, a veteran’s thoughts of his or her own death or thoughts of engaging in suicide-related behavior, may cause occupational and social impairment with deficiencies in most areas.” Bankhead v. Shulkin, 29 Vet. App. 10 (2017). The Veteran endorsed passive suicidal ideation with no documentation of plan or intent. Given the severity, frequency, and duration of this manifestation, the Board finds that the overall disability picture did not cause occupational and social impairment with deficiencies in most areas. To this end, the Veteran reported that she was close to her husband, father and two children. She also reported having one close friend, who she saw a few times a week. She did report not being close to her mother, having arguments with her husband, and having difficulty in socializing with people she did not know. Moreover, the August 2018 VA examiner reported that the Veteran’s mental health could cause her to experience mild difficulty responding appropriately to supervision and relating effectively to co-workers, mild difficulty concentrating, and mild to moderate difficulty sustaining persistence and pace and adapting to change. Significantly, there is no indication that the Veteran’s occupational and social functioning was indicative of deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood at any time during the appeal period. See Vazquez-Claudio, supra. Moreover, total occupational and social impairment has not been shown. Specifically, the evidence does not demonstrate total occupational and social impairment due to such symptoms as gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; intermittent inability to perform activities of daily living; or disorientation to time or place. There is no indication of total occupational and social impairment in the record. The evidence of record does not show that the Veteran’s PTSD has caused total occupational impairment. Although she was unemployed throughout the appeal period, no medical professional has provided any opinion indicating that the Veteran’s psychological symptoms have caused an inability to obtain or maintain gainful employment. Moreover, the evidence of record does not show that the Veteran’s service-connected psychiatric disability has produced total social impairment. Accordingly, in this case, the symptoms shown in the examination and treatment records do not equate to the symptoms contemplated for a 100 percent schedular rating at any time during the appeal period. In sum, the extent and severity of the Veteran’s PTSD symptoms reported and/or shown are suggestive of occupational and social impairment, with reduced reliability and productivity due to such symptoms as disturbances of motivation and mood, difficulty concentrating, sleep disturbance, irritability, and anxiety; i.e., the level of impairment contemplated in the assignment of a 50 percent rating for psychiatric disabilities. See Mauerhan, supra, Vazquez-Claudio, supra. More severe symptomatology was not shown. Accordingly, the probative evidence of record does not support a finding that a rating in excess of 50 percent is warranted for the Veteran’s service-connected PTSD at any time during the appeal period. The preponderance of the evidence is against the Veteran’s claim for a higher rating. Consequently, the benefit-of-the-doubt rule does not apply. 38 U.S.C. § 5107(b); Gilbert, 1 Vet. App. at 55. While there may have been day-to-day fluctuations in the manifestations of the Veteran’s service-connected PTSD, the evidence shows no distinct periods of time during the appeal period, when her disability varied to such an extent that a rating greater or less than 50 percent would be warranted. Hart, supra. 2. A rating in excess of 10 percent for carpal tunnel syndrome, right arm, is denied. The Veteran asserts that her carpal tunnel syndrome, right arm, has increased in severity and is entitled to a rating in excess of 10 percent. The Board notes that the Veteran’s carpal tunnel syndrome is rated by analogy under 38 C.F.R. § 4.124a, Diagnostic Code 8599-8515. The Veteran filed her claim for an increased rating for carpal tunnel syndrome, right arm, in excess of 10 percent, which was received by VA on September 13, 2017. A May 2018 rating decision denied her claim. The Veteran disagreed and this appeal ensued. The Veteran’s disability rating is assigned pursuant to Diagnostic Code 8515. Under Diagnostic Code 8515, a disability rating of 10 percent is assigned for mild incomplete paralysis of either upper extremity, and a disability rating of 20 percent is assigned for moderate incomplete paralysis of the non-dominant upper extremity. A disability rating of 30 percent is assigned for moderate incomplete paralysis of the dominant upper extremity, and a disability rating of 40 percent is assigned for severe incomplete paralysis of non-dominant upper extremity. A disability rating of 50 percent is assigned for severe incomplete paralysis of the dominant upper extremity, and a disability rating of 60 percent is assigned for complete paralysis of the non-dominant extremity. Finally, a disability rating of 70 percent is assigned for complete paralysis of the dominant extremity. 38 C.F.R. § 4.124a, Diagnostic Code 8515. The rating criteria do not define mild, moderate, or severe, but the Board is required to decide cases equitably. Additionally, characterizations of the severity of his or her symptoms of radiculopathy made by medical providers are not binding on the Board. Private treatment records dated in June 2017 documented the Veteran’s report of numbness in both hands. In September 2017, she indicated that she experiences constant tingling in the fingers of both hands. The Veteran was afforded a VA examination in May 2018. The examiner noted that the Veteran was diagnosed with carpal tunnel syndrome in both arms, in 2012 and was right hand dominant. On examination, the Veteran did not show any signs of pain, had full strength in all areas, had normal reflexes, and normal sensory results. There was a showing of mild numbness in her right upper extremity. Special testing was performed for median nerve evaluation and Phalen’s sign was positive for both the right and left side and Tinel’s sign was negative for both sides. The Veteran’s median nerve showed bilateral mild incomplete paralysis, with all other nerves shown to be normal. The examiner reported that the Veteran’s symptoms seem to be somewhat intermittent and that she was never prescribed a wrist splint for either wrist. The Veteran described occasional numbness, with no pain. In an August 2018 addendum opinion, the VA examiner stated that the Veteran’s only complaint regarding her bilateral carpel tunnel syndrome is intermittent numbness. There was no motor or sensory loss noted on the examination. The examiner further stated that the veteran has no functional or occupational limitations caused by her bilateral carpel tunnel syndrome. Here, the competent evidence of record shows that the Veteran’s carpal tunnel, right arm, has been shown to cause mild, incomplete paralysis of the median nerve. Even when viewing the evidence in a light most favorable to the Veteran, the Board cannot conclude that her statement, that she experiences occasional numbness, with no pain, is best characterized by moderate, severe, or complete paralysis in her right arm. Accordingly, a rating in excess of 10 percent for carpal tunnel syndrome, right arm is denied. 3. A rating in excess of 10 percent for carpal tunnel syndrome, left arm is denied. The Veteran asserts that her carpal tunnel syndrome, left arm, has increased in severity and is entitled to a rating in excess of 10 percent. The Board notes that the Veteran’s carpal tunnel syndrome is also rated by analogy under 38 C.F.R. § 4.124a, Diagnostic Code 8599-8515. The Veteran filed her claim for an increased rating for carpal tunnel syndrome, left arm, in excess of 10 percent, which was received by VA on September 13, 2017. A May 2018 rating decision denied her claim. The Veteran disagreed and this appeal ensued. Private treatment records dated in June 2017 documented the Veteran’s report of numbness in both hands. In September 2017, she indicated that she experiences constant tingling in the fingers of both hands. The Veteran was afforded a VA examination in May 2018. The examiner noted that the Veteran was diagnosed with carpal tunnel syndrome in both arms in 2012 and was right hand dominant. On examination, the Veteran did not show any signs of pain, had full strength in all areas, had normal reflexes, and normal sensory results. There was a showing of mild numbness in both upper extremities. Special testing was performed for median nerve evaluation and Phalen’s sign was positive for both the right and left side and Tinel’s sign was negative for both sides. The Veteran’s median nerve showed bilateral mild incomplete paralysis, with all other nerves shown to be normal. The examiner reported that the Veteran’s symptoms seem to be somewhat intermittent and that she was never prescribed a wrist splint for either wrist. The Veteran described occasional numbness, with no pain. In an August 2018 addendum opinion, the VA examiner stated that the Veteran’s only complaint regarding her bilateral carpel tunnel syndrome is intermittent numbness. There was no motor or sensory loss noted on the examination. The examiner further stated that the veteran has no functional or occupational limitations caused by her bilateral carpel tunnel syndrome. Here, the competent evidence of record shows that the Veteran’s carpal tunnel, left arm, has been shown to cause mild, incomplete paralysis of the median nerve. Even when viewing the evidence in a light most favorable to the Veteran, the Board cannot conclude that her statement, that she experiences occasional numbness, with no pain, is best characterized by moderate, severe, or complete paralysis in her left arm. Accordingly, a rating in excess of 10 percent for carpal tunnel syndrome, left arm, is denied. 4. A rating in excess of 10 percent for left hip bursitis is denied. The Veteran asserts that her left hip bursitis has increased in severity and that she is entitled to a rating in excess of 10 percent for her left hip. The Veteran’s left hip is rated under Diagnostic Code 5019-5252. The Veteran filed her claim for an increased rating for left hip bursitis, in excess of 10 percent, which was received by VA on September 13, 2017. A May 2018 rating decision denied her claim. The Veteran disagreed and this appeal ensued. With respect to disabilities of the hip, 38 C.F.R. § 4.71a, Diagnostic Codes 5250 through 5255 set forth relevant provisions. Diagnostic Code 5250 evaluates ankylosis of the hip. The evidence of record does not document ankylosis in the left hip. Therefore, this Diagnostic Code is not applicable and will not be discussed further. Diagnostic Code 5251 evaluates limitation of extension. A 10 percent rating is assigned for extension limited to 5 degrees. Diagnostic Code 5252 evaluates limitation of flexion. A 10 percent rating is assigned for flexion limited to 45 degrees. A 20 percent rating is assigned for flexion limited to 30 degrees. A 30 percent rating is assigned for flexion limited to 20 degrees. A 40 percent rating is assigned for flexion limited to 10 degrees. Diagnostic Code 5253 evaluates an impairment of the thigh. A 10 percent rating is assigned for limitation of rotation to 15 degrees or limitation of adduction resulting in an inability to cross legs. A 20 percent rating is assigned for loss of abduction beyond 10 degrees. Diagnostic Code 5254 evaluates hip flail joint. The evidence of record does not document a hip flail joint in the left hip. Therefore, this Diagnostic Code is not applicable and will not be discussed further. Diagnostic Code 5255 evaluates impairment of the femur. The evidence of record does not document an impairment of the femur in the left hip. Therefore, this Diagnostic Code is not applicable and will not be discussed further. Hip flexion is measured from 0 degrees to 125 degrees; abduction is measured from 0 degrees to 45 degrees. 38 C.F.R. § 4.71a, Plate II. The Veteran’s treatment records show that she has ongoing physical therapy for her hip condition. However, her treatment records fail to establish that a hip rating in excess of 10 percent, for the left hip, is warranted. The Veteran reported in March 2018 that she was doing a lot better with her hip pain. She stated that she was able to carry her children now and was able to crawl into the back of her sport utility vehicle (SUV) without increased pain. The Veteran was afforded a VA examination in May 2018. The Veteran did not report having flare-ups in her hips. The Veteran reported that she was unable to run due to the right inguinal pain. On examination, she demonstrated bilateral hip flexion to 120 degrees, full extension to 30 degrees, full abduction to 45 degrees, full adduction to 25 degrees, and full external and internal rotation. She demonstrated left hip full adduction to 25 degrees, and full external and internal rotation. There was no pain noted on examination for the left hip and no pain on palpation. There was no objective evidence for crepitus for either hip. The Veteran was able to perform repetitive use testing for both hips with no loss of function or range of motion after three repetitions. On muscle strength testing, the Veteran showed full strength in all areas, for both hips. There was no evidence of ankylosis, hip flail joint, or impairment of the femur. The examiner noted that there was no evidence of pain during passive range of motion of the hip joints and there was no evidence of pain when the hip joints were non-weight bearing. In an August 2018 VA addendum opinion, the examiner stated that the Veteran reports some residual hip pain, but has no functional or occupational limitations and could easily function in an office position or even one of light physical activity. Regarding limitation of extension, the Veteran’s treatment records do not document compensable limitation of extension. At the May 2018 VA examination, she showed full extension to 30 degrees in her left hip, even when considering pain. Thus, the Veteran did not meet the criteria for a compensable rating for limitation of extension, which requires extension limited to 5 degrees. Regarding limitation of flexion, the Veteran’s treatment records do not document compensable limitation of flexion. At the May 2018 VA examination, she showed flexion to 120 degrees in her left hip, even when considering pain. Thus, the Veteran did not meet the criteria for a compensable rating for limitation of flexion, which requires flexion limited to 45 degrees. Regarding impairment of the thigh, the Veteran’s treatment records, nor does the May 2018 VA examination document the inability to cross legs, or loss of abduction beyond 10 degrees. Thus, the Veteran did not meet the criteria for a compensable rating for impairment of the thigh, regarding her left hip. Where a diagnostic code is predicated on loss of motion, VA must also consider 38 C.F.R. § 4.40, regarding functional loss due to pain, and 38 C.F.R. § 4.45, regarding weakness, fatigability, incoordination, or pain on movement of a joint. DeLuca v. Brown, 8 Vet. App. 202 (1995). Here, the Board notes that the Veteran is currently in receipt of the minimum compensable rating for her left hip because of painful motion. The evidence of record does not establish that the Veteran’s left hip bursitis rises to the level of assignment of a rating in excess of 10 percent for her left hip. Here, her left hip symptoms that have been described, as pain, are consistent with the assigned ratings during the period on appeal. Accordingly, a rating in excess of 10 percent for left hip bursitis is denied. 5. A rating in excess of 10 percent for femoral neck stress fracture of the right hip is denied. The Veteran asserts that her femoral neck stress fracture of the right hip has increased in severity and that she is entitled to a rating in excess of 10 percent for her right hip. The Veteran’s right hip is rated under Diagnostic Code 5252. The Veteran filed her claim for an increased rating for femoral neck stress fracture of the right hip, in excess of 10 percent, which was received by VA on September 13, 2017. A May 2018 rating decision denied her claim. The Veteran disagreed and this appeal ensued. The Veteran’s treatment records show that she has ongoing physical therapy for her hip conditions. However, her treatment records fail to establish that a hip rating in excess of 10 percent, for her right hip, is warranted. The Veteran reported in March 2018 that she was doing a lot better with her hip pain. She stated that she was able to carry her children now and was able to crawl into the back of her sport utility vehicle (SUV) without increased pain. The Veteran was afforded a VA examination in May 2018. The Veteran did not report having flare-ups in her hips. The Veteran reported that she was unable to run due to the right inguinal pain. On examination, she demonstrated bilateral hip flexion to 120 degrees, full extension to 30 degrees, full abduction to 45 degrees, full adduction to 25 degrees, and full external and internal rotation. She demonstrated right hip full adduction to 25 degrees, and full external and internal rotation. Pain was noted on examination for flexion of the right hip, but did not result in or cause functional loss. There was no evidence of pain on weight bearing for the right hip, but there was localized tenderness at the right mid inguinal ligament. There was no objective evidence for crepitus for either hip. The Veteran was able to perform repetitive use testing for both hips with no loss of function or range of motion after three repetitions. On muscle strength testing, the Veteran showed full strength in all areas, for both hips. There was no evidence of ankylosis, hip flail joint, or impairment of the femur. The examiner noted that there was no evidence of pain during passive range of motion of the hip joints and there was no evidence of pain when the hip joints were non-weight bearing. In an August 2018 VA addendum opinion, the examiner stated that the Veteran reports some residual hip pain, but has no functional or occupational limitations and could easily function in an office position or even one of light physical activity. Regarding limitation of extension, the Veteran’s treatment records do not document compensable limitation of extension. At the May 2018 VA examination, she showed full extension to 30 degrees in her right hip, even when considering pain. Thus, the Veteran did not meet the criteria for a compensable rating for limitation of extension, which requires extension limited to 5 degrees. Regarding limitation of flexion, the Veteran’s treatment records do not document compensable limitation of flexion. At the May 2018 VA examination, she showed flexion to 120 degrees in her right hip, even when considering pain. Thus, the Veteran did not meet the criteria for a compensable rating for limitation of flexion, which requires flexion limited to 45 degrees. Regarding impairment of the thigh, the Veteran’s treatment records, nor does the May 2018 VA examination document the inability to cross legs, or loss of abduction beyond 10 degrees. Thus, the Veteran did not meet the criteria for a compensable rating for impairment of the thigh, regarding her right hip. Where a diagnostic code is predicated on loss of motion, VA must also consider 38 C.F.R. § 4.40, regarding functional loss due to pain, and 38 C.F.R. § 4.45, regarding weakness, fatigability, incoordination, or pain on movement of a joint. DeLuca v. Brown, 8 Vet. App. 202 (1995). Here, the Board notes that the Veteran is currently in receipt of the minimum compensable rating for her right hip because of painful motion. The evidence of record does not establish that the Veteran’s femoral neck stress fracture of the right hip rises to the level of assignment of a rating in excess of 10 percent for her right hip. Here, her right hip symptoms that have been described, as pain, are consistent with the assigned ratings during the period on appeal. Accordingly, a rating in excess of 10 percent for femoral neck stress fracture of the right hip is denied. 6. A rating in excess of 10 percent for a lower back strain is denied. The Veteran asserts that her lower back strain causes her to be unable to lift anything over 20 pounds, sit or stand for long periods of time, walk very far, and makes it difficult to play with her children. She asserts that she is entitled to a rating in excess of 10 percent for her lower back strain. The Veteran’s lower back strain is rated under Diagnostic Code 5237 and is based on painful motion. 38 C.F.R. § 4.59. The Veteran filed her claim for an increased rating for her lower back strain, in excess of 10 percent, which was received by VA on September 13, 2017. A May 2018 rating decision denied her claim. The Veteran disagreed and this appeal ensued. Back disabilities are currently rated under either the General Rating Formula for Diseases and Injuries of the Spine or the Formula for Rating Intervertebral Disc Syndrome (IVDS) based on Incapacitating Episodes, whichever method results in the higher evaluation when all disabilities are combined. 38 C.F.R. § 4.71a. Under the current Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, a 10 percent rating is assigned when IVDS causes incapacitating episodes having a total duration of at least one week but less than two weeks during a 12-month period on appeal. A 20 percent rating is assigned when IVDS causes incapacitating episodes having a total duration of at least two weeks but less than four weeks during a 12-month period on appeal. A 40 percent rating is assigned when IVDS causes incapacitating episodes having a total duration of at least four weeks but less than six weeks during a 12-month period on appeal. A 60 percent rating is assigned when IVDS causes incapacitating episodes having a total duration of at least six weeks during a 12-month period on appeal. 38 C.F.R. § 4.71a, Diagnostic Code 5243. An incapacitating episode is a period of acute signs and symptoms due to IVDS that requires bed rest prescribed by a physician and treatment by a physician. 38 C.F.R. § 4.71a, Diagnostic Code 5243, Note (1). The evidence of record does not show that the Veteran has experienced any IVDS. The May 2018 VA examiner indicated that the Veteran did not have IVDS. Moreover, there is no evidence showing that the Veteran has been prescribed any bed rest to treat either her lower back strain. Because the prescription of bed rest is a foundational requirement of a rating under this section of the rating schedule, the absence of any prescribed bed rest precludes a rating from being assigned under it. As such, a rating based on IVDS is not appropriate, and it is therefore more beneficial to evaluate the Veteran’s lumbar spine disability under the General Rating Formula for Diseases and Injuries of the Spine. Under the General Rating Formula for Diseases and Injuries of the Spine, a 10 percent evaluation is warranted if forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; the combined range of motion of the thoracolumbar spine is greater than 120 degrees but not greater than 235 degrees; if there is muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or if there is vertebral body fracture with loss of 50 percent or more of the height. A 20 percent evaluation is warranted if forward flexion of the thoracolumbar spine is greater than 30 degrees but not greater than 60 degrees; the combined range of motion of the thoracolumbar spine is not greater than 120 degrees; or if there is muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. A 40 percent evaluation is warranted if forward flexion of the thoracolumbar spine is 30 degrees or less or there is favorable ankylosis of the entire thoracolumbar spine. A 50 percent evaluation is warranted if there is unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent evaluation is warranted for unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine. The Veteran’s treatment records show treatment for low back pain. While her treatment records show she has received physical therapy for her low back, her treatment records do not describe any limitation of range of motion in degrees. In May 2018, the Veteran was afforded a VA examination. The examiner noted that the Veteran was diagnosed with a lumbosacral strain. The examiner noted that the lumbosacral strain was a complication of her right femoral neck stress fracture (right hip disorder). The Veteran reported that she still has pain in her back that is aggravated with increased use. She did not report flare-ups or any functional loss or functional impairment of the thoracolumbar spine. On examination, the Veteran showed full range of motion for forward flexion, extension, right and left lateral flexion, and right and left lateral rotation. There was no evidence of pain with weight bearing or pain on palpation. The Veteran was able to perform repetitive use testing with at least three repetitions with no loss of function or range of motion. There was no guarding or muscle spasms of the thoracolumbar spine. On muscle strength testing, the Veteran showed full strength in all areas. She retained normal reflexes and sensation. The examiner indicated that the Veteran did not have ankylosis of the spine. The examiner reported that the Veteran stood up rapidly, turned rapidly, and walked rapidly, and exhibited no evidence of back pain. In an August 2018 VA addendum opinion, the examiner clarified that the physical examination of the Veteran’s low back revealed no pathology. The examiner stated that the Veteran is able to lift, carry, push, and pull. She has no functional or occupational limitations. Regarding the Veteran’s thoracolumbar spine disability, after a complete review of the medical record, the Veteran does not demonstrate limitation of motion (flexion) consistent with a 20 percent rating. At the May 2018 VA examination, the Veteran retained normal range of motion in all areas, with no pain noted on examination. At the May 2018 VA examination, she had a combined range of motion well in excess of 120 degrees. The May 2018 VA examiner indicated that the Veteran did not have muscle spasm or guarding. The medical record does not demonstrate findings consistent with a higher, 20 percent evaluation. As such, a rating in excess of 10 percent is not warranted for the Veteran’s thoracolumbar spine disability. In reaching this conclusion, the Board has considered whether a higher disability evaluation was warranted on the basis of functional loss due to pain or due to weakness, fatigability, incoordination, or pain on movement of a joint under 38 C.F.R. §§ 4.40 and 4.45. See also DeLuca v. Brown, 8 Vet. App. 202 (1995). Here, the Veteran is currently in receipt of the minimum compensable rating for her low back, under this provision. The Board additionally notes that, as indicated above, Note 1 of the General Rating Formula for Disease and Injuries of the Spine instructs to evaluate any associated objective neurologic abnormalities separately, under an appropriate Diagnostic Code. To this end, the Board notes that physical therapy records documented the Veteran’s report of radicular symptoms including numbness and tingling in the bilateral lower extremities with paresthesias radiating to the feet. See private treatment records dated June 2017 and July 2018. However, the May 2018 VA examiner specifically indicated that the Veteran does not have radiculopathy of either lower extremity. The question of entitlement to service connection for radiculopathy of the right and left lower extremities was denied in a November 2018 rating decision; the Veteran has not filed a NOD as to that rating decision. Moreover, the Veteran has not asserted, nor does the record indicate, that she suffers from any additional neurological impairment due to his service-connected low back disability. Accordingly, the criteria for a rating in excess of 10 percent for the Veteran’s lower back strain have not been met, and the claim is denied. 7. A rating in excess of 10 percent for early degenerative changes of the left knee is denied. The Veteran asserts that her left knee disability causes her difficulty in standing and walking for extended periods of time. She asserts that she is entitled to a rating in excess of 10 percent for her left knee disability. The Veteran’s left knee disability is rated under Diagnostic Code 5260 and is based on painful motion. 38 C.F.R. § 4.59. The Veteran filed her claim for an increased rating for her left knee disability, in excess of 10 percent, which was received by VA on September 13, 2017. A May 2018 rating decision denied her claim. The Veteran disagreed and this appeal ensued. Normal ranges of motion of the knee are to 0 degrees in extension, and to 140 degrees in flexion. 38 C.F.R. § 4.71, Plate II. Diagnostic Code 5260 evaluates limitation of knee flexion. A noncompensable rating is assigned for flexion limited to 60 degrees. A 10 percent rating is assigned for flexion limited to 45 degrees. A 20 percent rating is assigned for flexion limited to 30 degrees or extension limited to 15 degrees. A 30 percent rating is assigned for either flexion limited to 15 degrees or extension limited to 20 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5260. Diagnostic Code 5261 evaluates limitation of knee extension. A noncompensable rating is assigned for extension limited to 5 degrees. A 10 percent rating is assigned for extension limited to 10 degrees. A 20 percent rating is assigned for extension limited to 15 degrees. A 30 percent rating is assigned for extension limited to 20 degrees. A 40 percent rating is assigned for extension limited to 30 degrees. A 50 percent rating is assigned for extension limited to 45 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5261. Of note, separate compensable ratings may be assigned for limitation of flexion and for limitation of extension, without violating the rule against pyramiding. See 38 C.F.R. § 4.14. Diagnostic Code 5257 evaluates recurrent subluxation or lateral instability of the knee. A 10 percent rating is assigned for slight recurrent subluxation or lateral instability, a 20 percent rating is assigned for moderate recurrent subluxation or lateral instability, and a 30 percent rating is assigned for severe recurrent subluxation or lateral instability. 38 C.F.R. § 4.71a, Diagnostic Code 5257. The medical record does not document any instability problems and the Veteran has not asserted that she experiences instability or subluxation in her left knee. Therefore, this Diagnostic Code is not applicable and will not be discussed further. Diagnostic Codes 5258 and 5259 evaluate impairment of the semilunar cartilage. A 10 percent rating is assigned for removal of the meniscus that is symptomatic. A 20 percent rating is assigned for dislocated meniscus with frequent episodes of locking, pain, and effusion into the joint. 38 C.F.R. § 4.71a, Diagnostic Codes 5258-59. The medical record does not document any meniscus condition in her left knee. Therefore, these Diagnostic Codes are not applicable and will not be discussed further. Diagnostic Code 5256 evaluates ankylosis of the knee, Diagnostic Code 5262 evaluates impairment of the tibia and fibula, and Diagnostic Code 5263 evaluates genu recurvatum. The medical record does not document any of these conditions in her left knee. Therefore, these Diagnostic Codes are not applicable and will not be discussed further. The Veteran’s treatment records do not show findings consistent with higher ratings for her left knee. In May 2018, the Veteran was afforded a VA examination. The examiner noted that the Veteran was diagnosed with knee strains in both knees. The Veteran reported that her knee pain started when her hip pain began. The examiner noted that the Veteran was not observed limping during the examination. The Veteran reported that she does not have time to exercise, but her watch counts steps and she walks about two miles a day. She reported occasional swelling in her knees and that she has never seen an orthopedic surgeon for her knees. She did not report flare-ups or having any functional loss or impairment of the joints. On examination, the Veteran showed flexion in both knees to 130 degrees and showed full extension. The examiner noted that the Veteran’s range of motion in both knees did not itself contribute to functional loss. There was no pain noted on examination, no pain on weight bearing, or pain on palpation for either knee. The Veteran was able to perform repetitive use testing with at least three repetitions for both knees with no additional functional loss of range of motion. On muscle strength testing, the Veteran showed full strength in all areas, for both knees. There was no ankylosis noted in either knee. Joint stability testing showed no recurrent subluxation or lateral instability. The examiner noted that the Veteran has never had a meniscus condition. The examiner noted that there was no pain on passive range of motion of either knee and there was no evidence of pain when the knees were in a non-weight bearing mode (sitting). In August 2018 VA addendum opinion, the VA examiner noted that physical examination of both knees revealed no pathology. The examiner stated that the Veteran has no functional or occupational limitations regarding her knees. Regarding flexion, the Veteran demonstrated at the May 2018 VA examination flexion to 130 degrees in her left knee. There was no pain noted on examination, she was able to perform repetitive use testing, and did not report flare-ups. Her flexion to 130 degrees, exceeds the 60-degree limitation equivalent to a noncompensable rating. As such, the Veteran is not found to meet even the criteria for a noncompensable rating for her left knee, under Diagnostic Code 5260, which requires flexion to be limited to 60 degrees. Regarding limitation of extension, the Board finds that the criteria to assign a separate compensable rating under Diagnostic Code 5261 have not been met. At the May 2018 VA examination, the Veteran demonstrated full extension in her left knee, with no pain noted, well in excess of a 5-degree limitation, equivalent to a noncompensable rating. Accordingly, the Veteran is not found to meet even the criteria for a compensable rating for her left knee under Diagnostic Code 5261, which requires extension to be limited to 10 degrees. The Board has considered whether higher disability evaluations are warranted on the basis of functional loss due to pain or due to weakness, fatigability, incoordination, or pain on movement of a joint under 38 C.F.R. §§ 4.40 and 4.45 for both knees. See also DeLuca, 8 Vet. App. 202. Here, the Veteran is currently in receipt of the minimum compensable rating for her left knee disability, under this provision. The Veteran has indicated that she has pain in her knees when she stands or walks for extended periods of time. However, at the May 2018 VA examination, she was able to perform repetitive use testing and did not result in functional loss. Even considering her assertions, the Veteran nevertheless retained flexion and extension well in excess of noncompensable ratings. While the Veteran did not demonstrate range of motion that would support a compensable rating, a compensable rating was assigned based on the restrictions imposed by pain on the functioning of her left knee. As such, the evidence simply does not support the conclusion that the Veteran’s left knee disability results in findings consistent with higher ratings. Thus, greater ratings for limitations of flexion and extension are not warranted under DeLuca. While the Veteran has been shown to experience knee pain, the Court has held that even if range of motion was slightly limited by pain, pain alone is not sufficient to warrant a higher rating, as pain may cause a functional loss, but pain itself does not constitute functional loss. Mitchell v. Shinseki, 25 Vet. App. 32, 36-38 (2011). Rather, pain must affect some aspect of “the normal working movements of the body” such as “excursion, strength, speed, coordination, and endurance,” in order to constitute functional loss. Id. at 43; see 38 C.F.R. § 4.40. Here, the Veteran retained flexion and extension in her left knee in excess of a compensable rating, with no pain noted on examination. As such, there is no basis for higher ratings under Diagnostic Codes 5260 or 5261 for her left knee. Accordingly, a rating in excess of 10 percent for the Veteran’s left knee disability, have not been met, and the claim is denied. 8. A rating in excess of 10 percent for a right knee strain is denied. The Veteran asserts that her right knee disability causes her difficulty in standing and walking for extended periods of time. She asserts that she is entitled to a rating in excess of 10 percent for her right knee disability. The Veteran’s right knee disability is rated under Diagnostic Code 5260 and is based on painful motion. 38 C.F.R. § 4.59. The Veteran filed her claim for an increased rating for her right knee disability, in excess of 10 percent, which was received by VA on September 13, 2017. A May 2018 rating decision denied her claim. The Veteran disagreed and this appeal ensued. The Veteran’s treatment records do not show findings consistent with higher ratings for her right knee. In May 2018, the Veteran was afforded a VA examination. The examiner noted that the Veteran was diagnosed with a knee strain in both knees. The Veteran reported that her knee pain started when her hip pain began. The examiner noted that the Veteran was not observed limping during the examination. The Veteran reported that she does not have time to exercise, but her watch counts steps and she walks about two miles a day. She reported occasional swelling in her knees and that she has never seen an orthopedic surgeon for her knees. She did not report flare-ups or having any functional loss or impairment of the joints. On examination, the Veteran showed flexion in both knees to 130 degrees and showed full extension. The examiner noted that the Veteran’s range of motion in both knees did not itself contribute to functional loss. There was no pain noted on examination, no pain on weight bearing, or pain on palpation for either knee. The Veteran was able to perform repetitive use testing with at least three repetitions for both knees with no additional functional loss of range of motion. On muscle strength testing, the Veteran showed full strength in all areas, for both knees. There was no ankylosis noted in either knee. Joint stability testing showed no recurrent subluxation or lateral instability. The examiner noted that the Veteran has never had a meniscus condition. The examiner noted that there was no pain on passive range of motion of either knee and there was no evidence of pain when the knees were in a non-weight bearing mode (sitting). In August 2018 VA addendum opinion, the VA examiner noted that physical examination of both knees revealed no pathology. The examiner stated that the Veteran has no functional or occupational limitations regarding her knees. Regarding flexion, the Veteran demonstrated at the May 2018 VA examination flexion to 130 degrees in her right knee. There was no pain noted on examination, she was able to perform repetitive use testing, and did not report flare-ups. Her flexion to 130 degrees, exceeds the 60-degree limitation equivalent to a noncompensable rating. As such, the Veteran is not found to meet even the criteria for a noncompensable rating for her right knee, under Diagnostic Code 5260, which requires flexion to be limited to 60 degrees. Regarding limitation of extension, the Board finds that the criteria to assign a separate compensable rating under Diagnostic Code 5261 have not been met. At the May 2018 VA examination, the Veteran demonstrated full extension in her right knee, with no pain noted, well in excess of a 5-degree limitation, equivalent to a noncompensable rating. Accordingly, the Veteran is not found to meet even the criteria for a compensable rating for her right knee, under Diagnostic Code 5261, which requires extension to be limited to 10 degrees. The Board has considered whether higher disability evaluations are warranted on the basis of functional loss due to pain or due to weakness, fatigability, incoordination, or pain on movement of a joint under 38 C.F.R. §§ 4.40 and 4.45 for both knees. See also DeLuca, 8 Vet. App. 202. Here, the Veteran is currently in receipt of the minimum compensable rating for her right knee disability, under this provision. The Veteran has indicated that she has pain in her knees when she stands or walks for extended periods of time. However, at the May 2018 VA examination, she was able to perform repetitive use testing and did not result in functional loss. Even considering her assertions, the Veteran nevertheless retained flexion and extension well in excess of noncompensable ratings. While the Veteran did not demonstrate range of motion that would support a compensable rating, a compensable rating was assigned based on the restrictions imposed by pain on the functioning of her right knee. As such, the evidence simply does not support the conclusion that the Veteran’s right knee disability results in findings consistent with higher ratings. Thus, greater ratings for limitations of flexion and extension are not warranted under DeLuca. While the Veteran has been shown to experience knee pain, the Court has held that even if range of motion was slightly limited by pain, pain alone is not sufficient to warrant a higher rating, as pain may cause a functional loss, but pain itself does not constitute functional loss. Mitchell, 25 Vet. App. at 36-38. Rather, pain must affect some aspect of “the normal working movements of the body” such as “excursion, strength, speed, coordination, and endurance,” in order to constitute functional loss. Id. at 43; see 38 C.F.R. § 4.40. Here, the Veteran retained flexion and extension in her right knee in excess of a compensable rating, with no pain noted on examination. As such, there is no basis for higher ratings under Diagnostic Codes 5260 or 5261 for her right knee. Accordingly, a rating in excess of 10 percent for the Veteran’s right knee disability, have not been met, and the claim is denied. 9. TDIU Claim The United States Court of Appeals for Veterans Claims (Court) has held that a TDIU claim is part and parcel of an increased rating claim when raised by the record. Rice v. Shinseki, 22 Vet. App. 447 (2009). As a result, the Board has jurisdiction to consider the Veteran’s possible entitlement to a TDIU when the issue is raised by assertion or reasonably indicated by the evidence and is predicated, at least in part, on the severity of the service-connected disability in question, regardless of whether the RO has expressly addressed this additional issue. See VAOPGCPREC 6-96 (Aug. 16, 1996); see also Caffrey v. Brown, 6 Vet. App. 377 (1994). Here, the Veteran has asserted that she is entitled to a TDIU and the regional office (RO) denied her TDIU claim in November 2018. The Veteran is service-connected for the following disabilities; MDD rated at 50 percent, lower back strain rated at 10 percent, left hip bursitis rated at 10 percent, early degenerative changes of both knees rated at 10 percent, tinnitus rated at 10 percent, femoral neck stress fracture rated at 10 percent, carpal tunnel syndrome of the right arm rated at 10 percent, and carpal tunnel syndrome of the left arm rated at 10 percent. VA will grant a total rating for compensation purposes based on unemployability when the evidence shows that a Veteran is precluded, due to service-connected disabilities, from obtaining or maintaining any form of gainful employment consistent with his or her education and occupational experience. 38 C.F.R. §§ 3.340, 3.341, 4.16. Under the applicable regulations, benefits based on individual unemployability are granted only when it is established that the service-connected disability or disabilities are so severe, standing alone, as to prevent the retaining of gainful employment. Under 38 C.F.R. § 4.16, if there is only one such disability, it must be rated at least 60 percent disabling to qualify for benefits based on individual unemployability. If there are two or more such disabilities, there shall be at least one disability ratable at 40 percent or more and sufficient additional disability to bring the combined rating to 70 percent or more. Id. Where these percentage requirements are not met, entitlement to benefits on an extraschedular basis may be considered when a Veteran is unable to secure and follow a substantially gainful occupation due to service-connected disability, and consideration is given to the Veteran’s background including his or her employment and educational history. See 38 C.F.R. § 4.16 (b). In determining whether unemployability exists, consideration may be given to the Veteran’s level of education, special training, and previous work experience, but it may not be given to his or her age or to any impairment caused by nonservice-connected disabilities. See 38 C.F.R. §§ 3.341, 4.16, 4.19. Here, the Veteran has two or more disabilities, with her MDD rated at 50 percent and a combined rating of 80 percent. As such, she meets the schedular criteria for a TDIU. However, as will be discussed, the evidence of record does not suggest that the Veteran’s service-connected disabilities has rendered her unable to obtain or maintain substantially gainful employment at any time during the course of the appeal. The Veteran is not currently working and has not since 2017 as an assistant manager of a rental car company. The Veteran reported that she held her position for almost two years, until she had to cut her hours due to back and hip pain and was placed on short-term disability for sixty-days. After the short-term disability ended, she was offered long-term disability, but declined it and quit so that she could have more free time to attend physical therapy. In her notice of disagreement, the Veteran stated that she would have to frequently ice her back or take medicine due to being in pain and having to leave work early due to pain. In her March 2019 Form 9, the Veteran stated that she had to quit working because she was unable to perform the necessary job duties required, due to pain in her back, knees, and hips. She explained that her psychiatric symptoms make it difficult to sleep, causes anxiety, causes her to lash-out at co-workers and causes intrusive thoughts of hurting herself. At her May 2018 VA examinations and August 2018 VA addendum opinion for her service-connected lower back disability, hip disabilities, carpal tunnel syndrome in both arms, and knee disabilities; the respective examiners opined that the Veteran’s conditions did not impact her ability to work. The examiner for MDD reported that the Veteran’s mental health could cause her to experience mild difficulty responding appropriately to supervision and relating effectively to co-workers, mild difficulty concentrating, and mild to moderate difficulty sustaining persistence and pace and adapting to change. Here, there is no dispute that the Veteran’s physical disabilities causes impairment. She has stated that she had to quit her last job due to her physical pain. However, the evidence of record indicates that her physical condition has improved. For example, she reported in March 2018 that she was doing a lot better with her hip pain. She stated that she was able to carry her children now and was able to crawl into the back of her SUV without increased pain. At her VA examination for her back in May 2018, the examiner noted that the Veteran stood up rapidly, turned rapidly, and walked rapidly and exhibited no evidence of back pain during the examination. At her VA examination for her knee disabilities, the examiner noted that there was no pain on passive range of motion testing of either knee and there was no evidence of pain when her knees were in the sitting position. At her VA examination for her carpal tunnel syndrome, the examiner noted that her symptoms were somewhat intermittent with occasional numbness and no pain. Although the Veteran’s service-connected disabilities have caused her some impairment, the evidence of record does not support the conclusion that the Veteran’s service-connected physical disabilities render her unable to obtain or maintain substantially gainful employment. She reported having to quit her last job due to the pain she was experiencing, but at her 2018 VA examinations, her examiners found that her physical disabilities did not impact her ability to work. The Veteran’s psychiatric disability does impact her ability to respond to supervision, relate to co-workers, concentrating, and adapting to change, however, the weight of the evidence is against a finding that it renders her unable to obtain or maintain substantially gainful employment. She also reported having suicidal ideation, however, these thoughts were found to be passive and she never had a plan or intent. The Board notes that the Veteran has not advanced any medical or vocational evidence to the contrary. (Continued on the next page)   Accordingly, a TDIU is denied. Katherine Kiemle Buckley Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board E. Fu, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.